A biweekly overview of recent studies published by Institute investigators and their collaborators spans a wide variety of topics, including:

ACA Marketplace enrollment; COVID-19 vaccine safety surveillance; out-of-pocket spending for asthma care; polygenic risk scores as a tool for disease detection; pediatric BMI by geographic region; skin cancer prevention recommendations

For all faculty publications, see our Publications page. For up-to-date media coverage and research findings, visit In the Media, and follow us on Twitter. To search for a subject matter expert, visit our Investigator Directory.

How political orientation may affect attitudes and behavior related to participation in the ACA Marketplaces
Political orientation can be a powerful motivator of behavior and may affect attitudes and behavior related to participation in the ACA Marketplaces, which provide coverage with subsidies in the individual (non-group) insurance market. A team led by former research fellow Joachim Hero with Alison Galbraith and Alon Peltz assessed both the strength and financial consequences of partisanship for health insurance coverage decisions in the non-group health insurance market. They conducted a longitudinal panel survey of enrollees in non-group insurance plans offered by a single New England health insurance carrier in 2017. Results, published in Health Affairs, showed that Republican enrollees were less likely than Democratic enrollees of comparable subsidy eligibility to enroll through the Marketplaces and receive subsidies. The authors suggest that, to navigating the ongoing political polarization in the U.S. requires, public policies and the associated education and outreach should be optimized to ensure maximal efficacy regardless of political orientation.

Institute Investigator(s): Alison Galbraith, Alon Peltz
 

Preliminary surveillance of adverse health outcomes after COVID-19 vaccine
Surveillance of the safety of the COVID-19 vaccine is critical to ensure safety, maintain trust, and inform policy. A new study of surveillance data from the Vaccine Safety Datalink, co-authored by Katherine Yih and published in JAMA, examines whether mRNA COVID-19 vaccines are associated with an increased risk for adverse health events up to three weeks after vaccination. The study team analyzed surveillance data from 6.2 million persons who received 11.8 million doses of an mRNA vaccine between December 2020 and June 2021. While surveillance is ongoing, their results show no association between vaccination and selected serious health outcomes (including acute myocardial infarction, Bell palsy, cerebral venous sinus thrombosis, Guillain-Barré syndrome, myocarditis/pericarditis, pulmonary embolism, stroke, and thrombosis with thrombocytopenia syndrome) 1 to 21 days after vaccination.

Institute Investigator(s): Katherine Yih

A comprehensive look at out-of-pocket spending for asthma care
Understanding the actual burden of asthma-related out-of-pocket spending for patients can help clinicians create management plans and inform strategies to optimize medication adherence and timely care. A team including Alison Galbraith, Ann Chen Wu, and Fang Zhang analyzed out-of-pocket spending for asthma-related care for commercially insured patients across types of care and by income using enrollment, claims, and geocoded census tract data on income from a large U.S. commercial health plan from 2004-2016. Results, published in The Journal of Allergy and Immunology: In Practice, show that asthma-related OOP spending decreased over time both for patients enrolled in high-deductible health plans and for those in traditional plans. Compared to their higher-income counterparts, those patients living in the lowest-income areas showed a greater cost burden, spending less on controller medications and more on high-acuity care.
 

Institute Investigator(s): Alison Galbraith, Ann Chen Wu, Fang Zhang

Seeking consensus on medical interventions for those at high risk of skin cancer and resulting mortality
While solid organ transplant recipients run a high risk of cutaneous squamous cell carcinoma and increased risk of death from skin cancer, little evidence helps guide medical interventions in this population. A new consensus statement in JAMA Dermatology co-authored by Maryam Asgari examined the development and results of a Delphi panel of 48 dermatologists initiated to identify

consensus-based medical management recommendations for prevention. The study resulted in consensus on management strategies for prevention of cutaneous squamous cell carcinoma in solid organ transplant recipients in 5 of the 6 actinic damage and skin cancer index stages. Findings may influence the implementation of panel recommendations while high-level-of-evidence data is pending.

Institute Investigator(s): Maryam Asgari

Can where you live affect your BMI?
In the United States, pediatric obesity hovers around 35%. Well-documented risk factors such as socio-economic status and weight at birth are one dimension to understanding disparities in BMI, but more studies are needed to identify unknown factors – including regional influences. A new study in Obesity co-authored by Emily Oken used pooled data from 25 prospective cohort studies to describe the association of individual-level characteristics (sex, race/ethnicity, birth weight, maternal education) with child BMI within each US Census region and variation in child BMI by region. Results suggest that understanding regional influences can inform targeted efforts to mitigate BMI-related disparities among children.

Institute Investigator(s): Emily Oken